Choice and Consent: Communicative Challenges Faced in Multilingual Antenatal Settings

In this blog Dr Emma Brooks reflects upon her chapter, ‘Choice and consent: communicative challenges faced in multilingual antenatal settings’.  Emma is a lecturer on the Intercultural Communication programme at UCL Institute of Education.

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The idea that collaborative dialogue should be at the heart of consultations is a central premise of informed decision-making. Not only does a patient have the right to be informed about their care, but we recognise that when a per­son is in possession of clear information presented in a way that is comprehen­sible to them as an individual, they are better able to consider the risks and benefits of different treatment options before making any decisions. In the context of maternity care, although the focus generally lies on the monitoring and maintenance of  a healthy pregnancy and the promotion of supportive behaviours, an individual may still be required to make deci­sions - for example, deciding whether to consent to a routine intervention or, as the extracts shared in this chapter illustrate, considering more complicated choices derived from hypothetical scenarios.

This chapter aims to illustrate that choices are not always easy to make, and that communicating risk orally, and attempting to ensure that it is fully understood, is not merely a process of information transfer. In fact, it might be better understood as a dynamic interaction requiring acute attention to an individual’s views, values, existing knowledge and capacity to make decisions. However, the journey to establishing informed consent can be complexified by any number of additional complicating factors: for example, we know that time plays an important role determining the ways in which appointments are managed, and the ways in which questions are framed and answered may inadvertently promote the interactional dominance of maternity professionals at the expense of the individuals with whom they are working; we also know that consultations are characterised by an asym­metries of knowledge, where the biomedical agenda of medical professionals frequently takes precedence over the ‘lifeworld’ of a birthing person, whose pregnancy is a contextualised condition relative to their lived experience.  Where midwives and expectant individuals join consultations with differing institutional or personal goals and expectations, the discursive space needed to facilitate decision-making can be complexified.

This chapter focuses on a group of people who arguably face a greater number of potential hurdles to autonomous and informed decision-making than the wider UK population - migrants who are speakers of languages other than English. While some previous research recognises the fact that cultural difference may affect engagement and experience, other studies emphasise the intersectional nature of intercultural health encounters. These latter studies highlight the need to take into account the range of determinants which may work in combination to drive disproportionately adverse outcomes for maternal and infant health among diasporic groups.

The contribution to the volume takes a view from the perspective of sociolinguistics, a field where research­ers are guided by an understanding that the relationship between society and language is mutually constitutive. Therefore, in addition to analysis of societal structures and institu­tional processes, consideration is given to detailing aspects of linguistic and nonverbal communication. The thinking behind this, is that patterns of interaction can offer insight into how information is exchanged, and mutual understanding negotiated, not least because the communicative resources that a person has at their disposal will have an impact on their capacity to understand, respond to and/or follow clinical advice.

Drawing on data from antenatal consultations in a multicul­tural London hospital, the chapter includes authentic examples of linguistic mediation with professional interpreters and patient companions, as well as (multilingual) medical professionals who appear to bridge a communicative gap in the absence of formal interpreting provision. However, while the use of shared languages appears to enhance patient well-being and experience, this chap­ter also notes that a shared language may not always contribute to full comprehension: on occasion, technical terminology and unfamiliar vocabulary can prove difficult to both grasp and translate. The conversations illustrate that if meaning becomes a process of linguistic negotiation, understanding may become approximated, regardless of who is translating. As a result, it appears that everyday strategies of interpretation and communicative resourcefulness may sometimes inadvertently compromise the ways in which informed con­sent in multilingual encounters can be said to have been achieved. The chapter ends with a discussion of issues arising, the potential for unanticipated consequences in mediated interaction and an exploration of avenues for future enquiry.